This week, the World Health Organization (WHO) informed that “sugar-free sweeteners should not be used as a means of weight control or reducing the risk of non-communicable diseases” such as diabetes and heart disease.
Artificial sweeteners are either natural compounds or synthesized compounds that taste sweet like sugar – and are up to 400 times sweeter by weight – but provides no or negligible energy. For comparison, sugar contains 17 kj (or four calories) per gram, so a teaspoon of sugar would have 85 kilojoules.
Several types of artificial sweeteners are used in Australia. Some are synthetic, others are extracted from foods such as monk fruit and the stevia plant.
So what do the new WHO guidelines mean for people who have switched to artificial sweeteners for health reasons? Should they just go back to sugar?
Promote for weight loss
As a practicing clinical dietitian in the 1990s, I remember when artificial sweeteners started showing up in processed foods. They have been promoted as a way to replace sugar in food products that can lead to weight loss.
A can of sweet carbonated drink contains on average about 500kj. Theoretically, replacing a can of sugary pop with a can of artificially sweetened pop every day would reduce your weight by about 1 kg per month.
But research over the past few decades shows that doesn’t hold up.
What are the new tips based on?
WHO based its recommendation on a systematic review it conducted conducted. Its aim was to provide evidence-based advice on the use of artificial sweeteners for weight management and disease prevention.
weight management is important, since obesity increases the risk of diseases such as diabetes and certain types of cancer, which are the primary cause deaths worldwide.
THE WHO systematic review included data from different types of studies, which give us different information:
50 were randomized controlled trials (when scientists step in and make changes – in this case to diet – while keeping everything else constant, to see the impact of that change)
97 were prospective cohort studies (when scientists observe a risk factor in a large group of people over a period of time to see how it affects an outcome – without intervening or making changes)
47 were case-control studies (another type of observational study that follows and compares two groups of otherwise matched people, apart from the risk factor of interest).
Randomized controlled trials provide us with causal data, allowing us to say that the intervention led to the change we saw.
The prospective cohort and the case-control only give us associations or links. We cannot prove that the risk factors caused the results to change – in this case, weight – because other risk factors that the scientists did not take into account could be responsible. But they give great clues about what might be going on, especially if we can’t try because it’s unethical or dangerous to give or withhold specific treatments.
The WHO systematic review looked at body fat, non-communicable diseases and death.
For body fat, randomized controlled trials showed that those who consumed more artificial sweeteners weighed slightly less – an average of 0.71 kg – than those who consumed less or no artificial sweeteners.
But the cohort studies found that higher intakes of artificial sweeteners were associated with a higher BMI or body mass index (0.14 kg/m2) and a 76% increased likelihood of being obese.
Prospective cohort studies showed that for higher intakes of artificially sweetened beverages, there was a 23% increased risk of type 2 diabetes. If artificial sweeteners were consumed as a table item (which the consumer added to food and drink), there was a 34% increase in the risk of diabetes.
In people with diabetes, artificial sweeteners did not improve or worsen clinical indicators used to monitor their diabetes, such as fasting blood sugar or insulin levels.
Higher intakes of artificial sweeteners have been associated with an increased risk of type 2 diabetes, cardiovascular disease, and death in long-term prospective observational studies that followed participants for an average of 13 years.
But artificial sweeteners were not associated with differences in overall rates of cancer or premature death from cancer.
Overall, while randomized controlled trials suggested slightly greater weight loss in people who used artificial sweeteners, observational studies found that this group tended to have an increased risk of obesity and poorer outcomes. health matter.
Does the review have any shortcomings?
WHO advice led to some reviews because randomized controlled trials have shown some weight loss benefits from artificial sweetener use, albeit small.
However, the WHO makes it clear that its advice is based on multiple research designs, not just randomized controlled trials.
Additionally, the WHO rated the quality of the studies in the review as ‘low or very low certainty’.
Are they dangerous?
This review does not suggest that artificial sweeteners are dangerous or should be banned. The WHO scientific review did not address chemical or safety issues.
So is it better to eat sugar instead?
The answer is no.
In 2015, the WHO published added sugar intake guidelines to reduce the risk of overweight and obesity. Added sugars are found in processed and ultra-processed foods and beverages such as soft drinks, fruit drinks, sports drinks, chocolate and confectionery, flavored yogurts and muesli bars.
It recommended people consume no more than 10% of total energy intake, or about 50 grams (ten teaspoons) of sugar per day for an average adult who needs 8,700 kj per day.
The WHO recommendation is consistent with Australian Dietary Guidelines, which recommends no more than three servings of discretionary foods per day, if you need extra energy. However, getting extra energy from major food groups (grains, vegetables, fruits, dairy, and protein) is better than discretionary foods.
So what am I drinking now?
So if artificial and sugary drinks are not advised for weight loss, what can you drink?
Some options include water, unsweetened kombucha, tea, or coffee. Sodas and mineral water flavored with a small amount of your favorite fruit juice are good substitutes.
Milk is also a good option, especially if you are not currently meeting your calcium needs.